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Noticed Number Of Freckles On Ankles And Feet. Had Arthritis. What Can Be The Cause?

Posted on Mon, 8 Jul 2013

Question: Hello Doc. I am a 67 yo male who was just pronounced amazingly fit for someone of any age. I just returned from back to back trips to Ethiopia and Lebanon. When bathing this morning I noticed a larger number of freckles on my ankles. It appears that they came on suddenly. I never had freckles on the upper portions of my feet until I had Lyme disease back in the mid-nineties. That was EVENTUALLY cleared up with massive regimens of anti-biotics. Had some neurological damage and arthritis but most symptoms have lessoned due to my intense athletic regime. Kinda worrisome that I have the freckles again. What can cause that? YYYY@YYYY

Answered by Dr. S. Jegadeesan (1 hour later)

Hello Sir,
Thanks for your inquiry
I am glad to note that you are very healthy for your age. Usually Freckles are due to increased deposit of melanin, dark brown in color - due exposure to sunlight or UV light/radiation.
So more common in the body where sun exposure is possible. Sometime Genetic and old age may play a role..
As you have this large number of freckles in the ankles - It may be purpuric skin eruptions called as "Petechiae". It would be good if you can take a picture and upload them here.
Sun light exposure freckles are harmless and treatment is not indicated and it may vanish in winter, and even if persists no harm.
Petechiae are due to the inflammation of the blood vessels called as vaculitis.
This condition calls for investigations and treatment right away
This is just my suggestion because of its location. Consult a doctor and get clear about the diagnosis.
With all good wishes

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. S. Jegadeesan (5 hours later)

Dear Dr. Subbiah.

I have attached a fairly close-up image of the discolored section of an ankle as you suggested. I welcome any further comment.

Thank you, XXXXX

Answered by Dr. S. Jegadeesan (3 hours later)

Hello,

Thanks for your follow up.

After viewing the image it looks like a Petechial rash.
The bleeding that takes place in the skin are called in three terms
1)     Petechiae – smaller lesion (minute hematoma) – measures < 3mm
2)     Purpura – larger lesion – may be palpable – measures 3 mm to 1 cm
3)     Ecchymoses – larger lesion – measures < 1 cm

All these three conditions do not blanch when pressed.
Other than Vasculitis, Allergy, Dietary deficiency of vitamin C also may be the cause.
It can be named as a nonspecific sign, but the underlying etiology may differ.

Etiologies are mainly concerned with blood disorders. So careful clinical testing and investigation play a major role to determine the underlying cause.
Consult a Hematologist and take proper treatment of the underlying cause, if any.

All my Best wishes and warm regards

Above answer was peer-reviewed by : Dr. Raju A.T